World Hepatitis Day: Awareness, Education and Early Detection of Liver Disease Critical for Addressing Hepatitis and Fatty Liver Disease
As World Hepatitis Day (WHD) approaches, it’s important to help raise awareness of the global burden of viral hepatitis—and its impact on liver health.
A large proportion of chronically hepatitis C virus (HCV)-infected persons in the U.S. are now about 50 – 70 years old and have lived with HCV infection for about 25 – 45 years. The diagnosis of HCV in this group can identify those with long-duration chronic disease, who were at risk for the most advanced forms of liver disease.
Palliative and hospice professionals are well-positioned to support patients who may be struggling with HCV or progressive liver disease or nearing end-off life. These individuals may be facing multiple chronic diseases, including HCV, nonalcoholic fatty liver disease (NAFLD)—the accumulation of excess fat in the liver of people who drink little or no alcohol—and its more severe form nonalcoholic steatohepatitis (NASH).
These professionals may also have opportunities to provide families and at-risk populations with education about the hidden epidemic of HCV, encourage testing and raise awareness about the nation’s significant and growing fatty liver disease (FLD) epidemic.
Know the Facts
A recent CDC report states that the total number of reported acute hepatitis C cases tripled from 2009 to 2018 and was highest among people ages 20–39. Their rates of acute infection increased about 300% during that period. Among adults ages 30 to 39, rates increased about 400%. In 2018, the largest proportion of chronic hepatitis C cases occurred among people ages 20–39 and those ages 50–69, who had almost equal infection rates. Only about 61% of adults with hepatitis C knew that they were infected.
Nearly one-third of Americans have asymptomatic liver disease. Approximately 85 million Americans have NAFLD, and 20% have NASH. Liver disease often leads to developing other issues, such as advanced fibrosis, increased risk of cardiovascular events and, in extreme cases, liver cancer, liver transplantation and death.
More than one-third of HCV-infected individuals progress to advanced fibrosis and cirrhosis, and among those with cirrhosis, about 3 – 5% per year develop decompensated cirrhosis and/or hepatocellular carcinoma (HCC).
One study on how NAFLD impacts patients treated and cured for HCV found that NAFLD identified in patients prior to treatment persisted after curing their HCV infection. Among those with NAFLD before treatment, 6.25% still had significant liver scarring after their HCV infection was cured.
Millions of Americans who are living with HCV will develop a chronic infection that, if left untreated, can cause serious health problems, including liver disease, cirrhosis, liver failure and liver cancer.
Prevention and Treatment
NAFLD can be reversible if caught in the early stages. Research suggests that weight management is the best approach to controlling or reversing NAFLD. Even a loss of 3-5% can improve liver health. Also, exercise and diet therapy for the elderly can reduce the fat accumulation in the liver and improve hyperlipidemia, hypertension and insulin resistance.
For elderly patients, the identification of advanced fibrosis and cirrhosis is essential for risk factor reductions, medical management and improvement in daily activities and quality of life.
An optimized treatment strategy for NAFLD requires a multidisciplinary approach. A non-pharmacological approach to treatment, such as diet, proper calorie intake and physical exercise, should be tailored individually and encompass the physical limitations of most elderly people.
VCTE tools, such as FibroScan, a non-invasive, painless and quick examination, is a medical non-imaging modality that quantifies the stiffness of liver tissue. Rapid results and test scores on these non-invasive screening tools are extremely helpful in providing additional information for providers, empowering them with data and information they can use in real time to refer patients to a specialist or recommend changes to their overall care plans, if needed. VCTE tools are covered by Medicare, Medicaid and many insurance plans, and can be operated by a medical assistant for immediate interpretation by a healthcare professional.
Author: Stephen Harrison, M.D., Gastroenterologist and Hepatologist, Medical Director of Pinnacle Clinical Research, and Visiting Professor of Hepatology, University of Oxford